8/8/2019 Unemployment Tax Form 1040WH

1/1

TAX LIABILITY

UNEMPLOYMENT INSURANCE

Any unemployment benets you receive are fully taxable if you are required to le a tax return. You

ay need to make estimated tax payments. For more tax information consult IRS publication 505,Tax Withholding and Estimated Tax, and the Oregon Department of Revenue.

At the end of January each year, the Employment Department will mail you a Form 1099-G, State-ment for Recipients of Unemployment Compensation. Form 1099-G tells you how much youreceived in benets last year. We also send a copy to the Internal Revenue Service and the StateDepartment of Revenue. If you received benets from a state other than Oregon, the other state also

ill send you a Form 1099-G.

e send your 1099-G statement to the last address we have on le for you. Please notify us in writ-ing of your address change, even if you stopped reporting on your claim. If you do not receive yourstatement by the second week of February, notify your nearest Employment Department ofce. If

ou have questions about your taxes, contact the Internal Revenue Service, State Department ofRevenue or a tax consultant.

ou may have the Employment Department withhold state and federal income taxes from anyunemployment benets paid starting on January 1, 1997. You may change your withholding statusin writing at any time. If you choose to have taxes withheld, your 1099-G will include the amount

ithheld during the preceding calendar year.

UTHORIZATION for TAX WITHHOLDING

Name (please print) Social Security Number: Beneft Yearending date:

TART I authorize the State of Oregon Employment Department to startwithholding:

10% of my unemployment benets for federal income taxes.

6% of my unemployment benets for state income taxes.

TOP I authorize the State of Oregon Employment Department to stop withholding:

10% of my unemployment benets for federal income taxes.

6% of my unemployment benets for state income taxes.

I understand that my election to discontinue withholding will remain in effect until I submit to theEmployment Department a signed request that withholding be restarted. I understand that benetspreviously withheld for taxes will not be refunded to me by the Employment Department.

I understand that this authorization will override any previous authorization.

Your Signature Todays Date

State of Oregon Employment Department Form 1040WH (2-03)